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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700290
Report Date: 11/01/2022
Date Signed: 11/01/2022 12:31:30 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/04/2022 and conducted by Evaluator Victoria Brown
COMPLAINT CONTROL NUMBER: 27-AS-20220404184941
FACILITY NAME:JASMINE-HALL IFACILITY NUMBER:
342700290
ADMINISTRATOR:HALL, ESTELA OFACILITY TYPE:
735
ADDRESS:4020 47TH STREETTELEPHONE:
(916) 452-6244
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY:4CENSUS: 1DATE:
11/01/2022
UNANNOUNCEDTIME BEGAN:
11:06 AM
MET WITH:Estela HallTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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The facility is not financially solvent.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conclude the complaint investigation on 11/1/22 at 11:06AM. LPA met with Estela Hall, Administrator and stated the purpose of the visit.

On 5/3/22 and 7/14/22 Community Care Licensing (CCL) requested the following documents to be submitted by 6/7/22 regarding proof of payment/establishment of a payment plan for Federal Tax Lien.
-Documents and Billing statements supporting assets, liabilities, loans and credit card accounts reported on Balance Sheet (LIC403) and Balance Sheet Supplemental Schedule (LIC403A) for April 2022.
-Billing statements and vendor invoices supporting revenues and expenditures reported on Monthly Operating Statement (LIC401) and Supplemental Financial Information (LIC401A)
-Food receipts/expenditures reported on LIC401
Substantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 27-AS-20220404184941
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: JASMINE-HALL I
FACILITY NUMBER: 342700290
VISIT DATE: 11/01/2022
NARRATIVE
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-Billing statement and vendor invoices for utilities including garage, telephone, cable, internet, and other costs-Workers compensation insurance policies to include current status
-Schedule of state tax deposits for January, February, March period (only the Quarterly Contribution Return and Report of Wages (EDD, (DE9)) was provided)
-Purpose of Federal Tax Lien filed on 12/2/21 and 4/12/22
-Proof of payment and/or establishment of payment plan(s) to include IRS contact information.
On 8/2/22, CCL met with the Licensee to discuss documents needed which was the third request.
To reiterate the Department during a audit solvency investigation the Licensee was requested to submit documentation summarizing all income and expenditures for the month of April 2022 and a corporate-level operating statement reflecting the combined results of all facilities for the month of April 2022.
The licensee(s) repeatedly provided historical information in lieu of requested items such as the LIC401 and LIC401A for the month of October 2017 and a corporate-level income statement for the period of July 2021 – March 2022.
The information that was submitted has limited relevance to the investigation. Licensee also provided an LIC401, and LIC401A for homes I, III, and VII. In addition, no supporting documents were provided to allow auditor to properly validate reported financial amounts.
The Licensee did not establish or maintain an adequate record keeping system of finances, no payroll summaries to support staff wages and benefits provided, no lease agreements or payments for November 2021-April 2022 provided, no utility billing statements, or vendor invoices were provided, and no current client census was provided for each facility, no liability policy was provided, no Workers Compensation Insurance documents were provided. Licensee confirmed census’ that the Department obtained. At this time there is 1 client in home I, 1 client in home III, and 2 clients in home VII. The Licensee did not provide documentation in a timely manner after several (at least three) attempts to allow auditor to properly investigate the allegation.
The Licensee did not provide adequate food receipts to justify the reported costs on LIC401 that was submitted which indicates the amounts were below the USDA suggested amounts.
The Licensee did not maintain authority in running the facility allowing George Hall to speak for the Licensee and run the facility without having the authority to do so. Mr. George Halls role in the facilities at this time is to inspect, maintain, upgrade or repair the facility properties as the property owner.
Throughout the course of the audit investigation, the Department conducted interviews and reviewed facility documents. Based on the audit investigation and documentation available, the following findings were determined that the licensee did not meet the following financial requirements:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20220404184941
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: JASMINE-HALL I
FACILITY NUMBER: 342700290
VISIT DATE: 11/01/2022
NARRATIVE
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1.Develop and maintenance of a financial plan, which ensures resources necessary to meet operating cost for care and supervision of all clients.
2.Maintenance of financial records.
3.Submission of records as required upon request of the Department or Licensing Agency.

The investigation revealed, the licensee does not have a financial plan in place. Furthermore, the licensee does not have sufficient resources to meet the operating costs for all residents in the E H Star Care Homes, Inc facilities: 1 thru 8. This could result in the licensee not having sufficient funds to maintain a cash reserve for emergencies.
Also, the income reported on the LIC 401, monthly operating statement form, was overstated. There were no supporting documents obtained during the audit. Moreover, it was learned that expenses were understated, and the net income was overreported.
1.The licensee does not have a financial plan that assures sufficient income to meet operating expense and is out of compliance of CCR 80062.
2.The licensee failed to provide documentation and information.
3. Failed to follow administrator qualifications and duties
4. Failed to exercise general supervisor of the licensed facility operation.
As a result of this audit investigation, the licensee does not have sufficient resources to meet the operating costs for all the E H Star Care Homes, Inc facilities. The licensee has also failed to cooperate with the solvency audit and has failed to conform to the inspection authority regulation. Based on the review of documentation submitted and the lack thereof, the preponderance of evidence standards has been met; therefore, the above allegation(s) is found to be SUBSTANTIATED.

A finding that the complaint allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, the following deficiencies are being cited on the attached 9099D during this visit. If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed. The Administrator was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights. An exit interview was conducted with E H Star Care Homes, Inc and a copy of this report was provided to E H Star Care Homes, Inc.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20220404184941
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: JASMINE-HALL I
FACILITY NUMBER: 342700290
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/14/2022
Section Cited
CCR
80062(a)(1-2)
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Finances
The licensee shall meet the following financial requirements: Development and maintenance of a financial plan which ensures resources necessary meet operating costs for care and supervision of clients. Maintenance of financial records.
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Licensee agrees to: make timely payments of all expenses concerning the facility, provide LIC401 to LPA monthly, maintain bills and records to be available for review by CCL, secure workers compensation insurance coverage, ensure operation remains solvent.
A letter of understanding shall be faxed to the CCL office.
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This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not maintain a financial plan and did not ensure to meet facilities’ operating costs. This posed a potential health and safety risk to residents in care.
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Type B
11/14/2022
Section Cited
CCR
80064(a)(3)(4)(6)
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Administrator -Qualifications and Duties
The administrator shall have the following qualifications: Knowledge of and ability to comply with applicable law and regulation. Ability to maintain or supervise the maintenance of financial and other records. Ability to establish the facility's policy, program and budget.
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Licensee agrees to: make timely payments of all expenses concerning the facility, provide LIC401 to CCL monthly, maintain bills, records and receipts to be available for review by CCL, ensure operation remains solvent. A letter of understanding shall be faxed to the CCL office.
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This requirement is not met as evidenced by: Based on interviews and records review, the Licensee did not maintain a financial plan and did not provide or have financial statements and other requested documents requested by the Department’s auditor readily available upon request. This posed a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20220404184941
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: JASMINE-HALL I
FACILITY NUMBER: 342700290
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/14/2022
Section Cited
CCR
80076(a)(1)
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Food Services
In facilities providing meals to clients, the following shall apply: All food shall be safe and of the quality and in the quantity necessary to meet the needs of the clients. Each meal shall meet at least 1/3 of the servings recommended in the USDA Basic Food Group Plan - Daily Food Guide for the age group served. All food shall be selected, stored, prepared and served in a safe and healthful manner.
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Licensee agrees to: maintain food receipts to be available for review by CCL upon request. A letter of understanding shall be faxed to the CCL office.
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This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not ensure food costs were in correlation to amounts reported on LIC401 and LIC401A. This posed a potential health and safety risk to residents in care.
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Type B
11/14/2022
Section Cited
CCR
86054(a)(m-o)
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Administrator Qualifications and Duties
In addition to Section 80064, the following shall apply. In those cases where the individual is both the licensee and the administrator of an adult residential facility, the individual shall comply with all of the licensee and certified administrator requirements. The Department may revoke the license of an adult residential facility for failure to comply with all requirements regarding certified administrators. Unless otherwise provided, a certified administrator may administer more than one licensed adult residential facility.
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Licensee agrees to: Uphold the duties of the Licensee for all facilities. A letter of understanding shall be faxed to the CCL office.

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This requirement is not met as evidenced by: Licensee allowing George Hall to speak on behalf of the facilities and produce documentation without the authority to do so. This posed a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5